Chest pain

“ If the patient responds, then GERD-related chest pain is the most likely diagnosis and maintenance treatment may be required. Failure to respond to a PPI suggests that acid reflux is not the problem although obviously this does not exclude nonacid reflux. In the absence of reflux, it is usually assumed that the problem may be due to a disorder of motility or sensation. On the assumption that esophageal contractions may be contributing to the pain, a variety of treatments aiming at relieving spasm have been evaluated. ”

“ Abstract Up to a third of patients undergoing coronary angiography for angina-like chest pain are found to have normal coronary arteries and a substantial proportion of these individuals continue to consult and even attend emergency departments. Initially, these patients are usually seen by cardiologists but with accumulating evidence that the pain might have a gastrointestinal origin, it may be more appropriate for them to be cared for by the gastroenterologist once a cardiological cause has been excluded. ”

“ SYMPTOMS.—The symptoms are those of perforation into the chest—sudden intense pain on the diseased side, with internal hemorrhage, great pallor, feeble circulation, cold extremities, and syncope. Patients often die in a few minutes. If the hemorrhage is moderate in quantity, they revive and the circulation returns, but they complain of feelings of suffocation and oppression. Slowly the general strength returns and the patient recovers. ”

“ Of course the only exact way of learning the nature of a chest trouble is thorough, careful examination by a physician, for cough, fever, rapid breathing and rapid pulse occur in many other diseases besides bronchitis, particularly pneumonia.
Pneumonia begins suddenly, often with a severe chill, headache, and general pains like grippe. In a few hours cough begins, short and dry, with violent, stabbing pain in one side of the chest, generally near the nipple. The breathing is rapid, with expanding nostrils, the face is anxious and often flushed. ”

“ Violent Pain: As if caused by external pressure on occiput, behind the left ear; in sacrum when lifting, they take her breath; in muscles of forearm, inside near elbow joint; in carpal and metacarpal bones, extending to shoulder; in palm of right hand, extending between thumb and forefinger, as if a pin were thrust through.
Sensation: In lungs as if struck by a cushion full of pins; anxiety in chest; skin of forehead feels too tight; tension in bend of left knee, as if swollen or sore. Cold or chilly sensation on right frontal protuberance ”

“ In the abdomen, and especially in the lower parts of the pelvis, this pleasant sensation of heat is more felt than in the chest—a fact which led to the application of gas to certain complaints in both sexes attended with torpor and debility of particular functions.
2. A sensation of twitching, formication, and even pain, is often the result of the gas-bath, especially in parts which have formerly been the seat of fractures, sprains, wounds, or severe gout or rheumatism. These pains are so acute as sometimes to force the patient to quit the bath before the usual time has expired. ”

“ Disturbance of the stomach with increase of saliva in the mouth as if emesis must occur, with stinging pains in the forehead and cold over the whole body, without thirst or feeling of heat following.
Hunger almost all the time.
Pain across the stomach as if a blow had been received.
The pain persists even after thirty-six hours.
On account of the severe pain in the stomach can only breathe slowly and carefully.
The pains in the stomach extend to the chest, causing oppression thereof, and then pass into the shoulders, with much belching and alternating pains in the throat and in the spine. ”

“ The heart is excited and rapid. The pain is located in the front of the chest or in the epigastrium, and the victims are a prey to great anxiety. Excessive trembling and inability to restrain muscular movements have been noticed. Profuse sweating, together with vomiting and evacuations of the bowels, may occur. Often the only record is, "Obscure symptoms, referable to the heart." There are no characteristics or pathognomonic symptoms of rupture of the aorta. Death is the invariable result, sooner or later, and no treatment has yet been devised to remedy the evil. ”

“ The dropsy of the chest commences with loss of flesh, cold extremities, pale countenance, high coloured urine in small quantity, and general debility, like many other dropsies. The patient next complains of numbness in the arms, especially when elevated, with pain and difficulty of swallowing, and an absolute impossibility of lying down for a few minutes, or with sudden starting from sleep, with great difficulty of breathing and palpitation of his heart. ”

“ The pain in the right70 side was in a few minutes entirely dissipated, and the patient arose, declaring, that, excepting a slight degree of uneasiness on the posterior part of the chest, near the angles of the inferior ribs of the left side, he was completely relieved from the disease. He, however, requested I would pass a needle in this last situation; on effecting which the pain soon left its last refuge, and the patient dressed himself, and left his house in the most perfect health. ”

“ Cough with greyish expectoration; cough with thick sputa; short, dry cough in the afternoon; very troublesome cough with white sputa and tasteless. Deep breathing at long intervals; breathing very rapid and hot.
Chest and throat: Aching in the lower part of the right chest, below the nipple. Stitches in the chest. Crampy pains in the lower part of chest. Transitory stitches in the chest, especially in the right side.
Pulse, quick and hard, feeble.
[Pg 41] Neck and back: Pain and debility in the nape of the neck.
Extremities: Numbness of the limbs, as if the limbs are paralyzed. ”

“ Owing to the greater liability of the light, or partly sanguine group, to active inflammations, a potent factor in causing this deficient size of the chest is inflammation, mainly pleurisy and pneumonia, and, as a not uncommon result, a collapse of one, or both, of the chest-walls. ”

“ Suddenly, or after a precedent feeling of pressure, there is severe griping pain in the pit of the stomach, usually extending into the back, with a feeling of faintness, shrunken countenance, cold hands and feet, and small, intermittent pulse. The pain becomes so excessive that the patient cries out. ”

“ Interference with the blood return to the heart may be due to causes within the chest, such as chronic bronchitis or heart obstruction, to swellings in the glands of the neck pressing on veins which convey the blood back to the heart, and improper dress, such as tight stays, or tight collars and cravats. ”

“ Pains of the side may be sometimes occasioned by the adhesion of the lungs to the pleura, after an inflammation of them; or to the adhesion of some abdominal viscera to their cavity, or to each other; which also are more liable to affect ladies from the unnatural and ungraceful pressure of tight stays, or by sitting or lying too long in one posture. But in these cases the pain should be more of the smarting, than of the dull kind. ”

“ After a period which varies much in different cases, inflammation, suddenly or gradually, is set up, and all the symptoms of acute obstruction are presented, grafted on signs of chronic occlusion. We have pain, nausea, vomiting, great distension and tenderness of the abdomen, peristalsis plainly seen and felt if the abdominal wall is thin, the small, frequent, wiry pulse, clammy perspiration, prostration with hiccough, tendinous twitchings, and death, very like that following a case of external strangulated hernia. ”

“ A slow and cautious step, a bending of the body, a laxity and flabby feel of the muscles of the arms, chest, and lower extremities, a tumid abdomen, or a swelling of the feet and ankles, are no indications of health. Tremulous hands mark age, nervousness, or intemperance. Hurried breathing, palpitation of the heart, frequent attacks of perspiration, sleeplessness, are all symptomatic of weakness, hysteria, or disease. Persons subject to bleedings, are usually of a waxy paleness, and soft fibre. ”

“ All wounds of the chest, though not involving bloodvessels of a large size, are productive of severe consequences—effusion of blood or bloody fluids into the cavities, escape of air into the external cellular tissue, collapse of the lung, and inflammation and its results, are always to be dreaded. The danger is not uniformly tantamount to the extent of injury inflicted. ”

“ Diseases of the chest are generally confined to heart, lungs, pleura, the pericardium, mediastium, blood vessels, with nerves and lymphatics. As we open the breast we behold the heart, a very large machine or engine, situated conveniently to throw blood to all parts of the body. To it we see hose or pipes that go to each organ, all muscles, the stomach, bowels, liver, spleen, kidneys, bladder and womb, all bones, fibers, ligaments, membranes, and its body, lungs and brain. ”

“ When some disease is about to fall upon the chest, it is usually announced by some of the following symptoms: There are profuse sweats over the whole body, and particularly about the chest, the tongue is rough, expectoration saltish, bitter, or bilious, pains suddenly seizing the sides or shoulder-blades, frequent yawning, watchfulness, oppressed respiration, thirst after sleep, despondency of mind, coldness of the breast and arms, trembling of the hands. These symptoms may be relieved in the following manner: Procure vomiting after a moderate meal without medicine. ”

“ If there be hoarseness, or cough, or stricture of lungs, or soreness of chest, place N. P., with long cord, upon back of neck, and treat with P. P. over the front part of neck and breast, and wherever upon the thorax stricture or soreness appears. ”

“ Jackson conveyed the news to the kitchen that there was only one thing the matter with Mr. Wyatt—he was clean off his head, that was all.
As Jackson left the library Wyatt dropped into a chair, his face contorted, covered with sweat, bending forward, his hands tightly fixed against his chest. That awful anginal pain! No, it had never been like that before. It must mean death. Ah, if he could only get to that bell! He tried to call. The words, 'Dr. Holling ... ”

“ Inability to breathe termed ORTHOPNŒA, occurs in affections of the heart, and also in asthma. Lying quietly in bed is usually a favorable sign. Restlessness and slipping 205to the foot of the bed, in low stages of fever, are bad signs.
Of the uneasy, morbid symptoms, pain is the most important, and most common. Pain occurs in nearly all inflammations, and it may occur where there is no inflammation at all.
Bones, muscles, tendons, ligaments, the bladder, the kidneys, the uterus, all modify in a manner that is peculiar to themselves the pain that is produced by injury or disease. ”

“ An acute, intense pain usually indicates inflammation of a nerve as well as the adjacent parts. Sharp, shooting, lancinating pains occur in inflammation of the serous tissues, as in pleurisy. A smarting, stinging pain attends inflammation of the mucous membrane. Acute pain is generally remittent and not fixed to one spot. Dull, heavy pain is more persistent, and is present in congestions, or when the substance of an organ is inflamed, and it often precedes hemorrhage. ”

“ The midriff is united, or fastened to the back bone, breast bone, and the middle of the ribs; therefore, we say the right and left portions float upward into the chest. How often is this part strained, and then called consumption! I allow there may be a cough, and tightness across the chest; but the real cause is, the lungs have lost their support, and consequently they wither and decay, unless you can strengthen the floor or support, that is, the ligaments; the symptoms are, you are unable to draw a long breath; if you go up stairs, your breath becomes short. ”

“ A man of 69 complains that as often as he walks any distance or climbs a stair he is arrested by a distressing sense of having a bar across the lower end of the sternum, breathlessness, irregular palpitation of the heart, and a very little choking in the throat; the discomfort has lately deserved the name of pain. His heart is very large, the area of præcordial dulness being increased in all directions and measuring transversely 7 inches. The impulse is weak over the left ventricle, but definite in the epigastrium ”

“ Inflammation of the Chest, Pneumonia or Pleurisy Inflammation of the chest usually involves both the pleura or lining membrane of the chest, and the substance of the lungs, so that they may be advantageously treated. ”

“ The simplest of the more serious results from injuries not penetrating the chest is the occurrence of inflammation, either of its lining membrane, giving rise to what is called pleuritis, or of the substance of the lung, termed pneumonia, or of both, constituting what has been named pleuro-pneumonia; but many severe blows on the chest are not followed by such serious consequences. ”

“ The pain is due to the pressure exerted on the sensory nerves by the surrounding swelling, as is well shown by the intensification of the distress, as every beat of the heart forces more blood into the space already filled. ”

“ The influence of the blood upon the sensibility of the skin, is further demonstrated by the pain experienced when chilled extremities are suddenly exposed to heat. The nerves, by the sudden dilatation of the contracted blood-vessels, are put in vivid and rapid motion, which causes the painful and tingling sensation that we experience. In every part of the system, sudden changes produce unpleasant sensations, and frequently a diseased condition of the organs. ”